Introduction: Neuropathy is a common chronic complication of diabetes mellitus, associated with discomfort and pain, substantially compromising the everyday life of sufferers. In a previous pilot trial we were able to demonstrate that high-frequency external muscle stimulation (HFEMS) effectively reduces neuropathic symptoms. More recently, we assessed the impact of HFEMS on neuropathic symptoms in a larger cohort in a 'real life' study design. Methods: In this study, 414 patients with symptomatic diabetic neuropathy used the HFEMS device HiToP®191 (gbo Medizintechnik AG). Symptom intensity and frequency were assessed in standardized telephone interviews before and at the end of the first week, at the end of the fourth week, and three weeks after finishing therapy. Results: HFEMS significantly reduced the intensity and frequency of all neuropathic symptoms in feet and lower legs, as well as disruptions during sleep (p< 0.0001 for all symptoms). Post-therapy symptoms recurred, but remained less intense and less frequent compared to baseline. In total, 88.4% of patients were responders and reported a reduction of symptoms with greater improvements seen in the female participants (p = 0.036), as well as in those with higher HbA1c (p = 0.027) and neuropathy symptom scores (NSS) at baseline (p = 0.0002). Conclusion: HFEMS improves symptoms of diabetic neuropathy. Free of side effects and effective in the majority of patients, it represents a valuable non-pharmacological therapy option for patients with diabetic neuropathy.